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Gupta N, Malla S, Tirlangi PK, Magazine R, Chandrashekar UK, Ravindra P, Bhat R, Varma M, Mukhopadhyay C. Reversed halo sign: Don't forget Melioidosis. J Travel Med 2024:taae036. [PMID: 38438163 DOI: 10.1093/jtm/taae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/16/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sundeep Malla
- Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Faridabad, India
| | - Praveen Kumar Tirlangi
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - U K Chandrashekar
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Prithvishree Ravindra
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rachana Bhat
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
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Siji AA, Sajikumar K, Chawla K, Magazine R, Kv R. Lung abscess by Streptococcus intermedius: An unusual first case report from India. Indian J Med Microbiol 2024; 48:100522. [PMID: 38141828 DOI: 10.1016/j.ijmmb.2023.100522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
A unique case report, probably first case from India, of lung abscess caused by Streptococcus intermedius in a previously untreated patient with Type 2 diabetes mellitus is reported here. The patient presented with non-productive cough and right-sided chest pain. Microbiological evaluation confirmed the presence of Streptococcus intermedius and the patient responded positively to antibiotic therapy. This case highlights the fact that S.intermedius may act as pathogen in immunocompromised individuals. So, a caution is needed by the medical fraternity before disregarding it as a commensal.
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Affiliation(s)
- Alfa A Siji
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Keerthana Sajikumar
- Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Rajagopal Kv
- Department of Radiodiagnosis, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
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Hazra D, SM F, Chawla K, Sintchenko V, Martinez E, Magazine R, Siddalingaiah N. The altered sputum microbiome profile in patients with moderate and severe COPD exacerbations, compared to the healthy group in the Indian population. F1000Res 2023; 12:528. [PMID: 37928173 PMCID: PMC10624950 DOI: 10.12688/f1000research.132220.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
Background: Microbial culture-independent sequencing techniques have advanced our understanding of host-microbiome interactions in health and disease. The purpose of this study was to explore the dysbiosis of airway microbiota in patients with moderate or severe chronic obstructive pulmonary disease (COPD) and compare them with healthy controls. Methods: The COPD patients were investigated for disease severity based on airflow limitations and divided into moderate (50%≤FEV1<80% predicted) and severe groups (FEV1<50% predicted). Spontaneous sputum samples were collected and, the V3-V4 regions of the 16S rRNA coding gene were sequenced to examine the microbiome profile of COPD and healthy participants. Results: A total of 45 sputum samples were collected from 17 severe COPD, 12 moderate COPD cases, and 16 healthy volunteers. The bacterial alpha diversity (Shannon and Simpson's index) significantly decreased in the moderate and severe COPD groups, compared to healthy samples. A significantly higher proportion of Firmicutes and Actinobacteria were present in moderate COPD, and Proteobacteria numbers were comparatively increased in severe COPD. In healthy samples, Bacteroidetes and Fusobacteria were more abundant in comparison to both the COPD groups. Among the most commonly detected 20 bacterial genera, Streptococcus was predominant among the COPD sputum samples, whereas Prevotella was the top genus in healthy controls. Linear discriminant analysis (LDA>2) revealed that marker genera like Streptococcus and Rothia were abundant in moderate COPD. For severe COPD, the genera Pseudomonasand Leptotrichia were most prevalent, whereas Fusobacterium and Prevotella were dominant in the healthy group. Conclusions: Our findings suggest a significant dysbiosis of the respiratory microbiome in COPD patients. The decreased microbial diversity may influence the host immune response and provide microbiological biomarkers for the diagnosis and monitoring of COPD.
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Affiliation(s)
- Druti Hazra
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Fayaz SM
- Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, New South Wale, 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, 2145, Australia
| | - Elena Martinez
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, 2145, Australia
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Nayana Siddalingaiah
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Chogtu B, Mariya Elenjickal V, Shetty DU, Asbin M, Guddattu V, Magazine R. Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia. Crit Care Res Pract 2023; 2023:6928319. [PMID: 37608868 PMCID: PMC10442184 DOI: 10.1155/2023/6928319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Flexible bronchoscopy (FB) is often performed in critically ill patients with suspected pneumonia. It is assumed that there will be an association with improved outcomes when bronchoalveolar lavage (BAL) data lead to a change in antimicrobial therapy. Methods. This study included a retrospective cohort of intensive care unit (ICU) patients who underwent FB for a diagnosis of suspected pneumonia. The study compared the outcome of patients in whom antimicrobial modification was carried out based on BAL reports versus those in whom it was not carried out. Cases where the procedure could not be completed or had incomplete records were excluded. The FB reports were accessed from the register maintained in the Department of Respiratory Medicine. The demographic details, clinical symptoms, laboratory investigations, and microbiological and radiology reports were recorded. Data on the antmicrobial therapy that the patients received during treatment and the outcome of the treatment were obtained from the case records and noted in the data collection form. Results. Data from a total of 150 patients admitted to the ICU, who underwent FB, were analyzed. The outcomes in the group where antimicrobial modification based on bronchoalveolar lavage (BAL) fluid reports was carried out versus the no-change group were as follows: expired 23, improved 82, unchanged 8 versus expired 12, improved 18, and unchanged 7 (p = 0.018); total duration of ICU stay 13.12 ± 10.61 versus 19.43 ± 13.4 days (p = 0.012); and duration from FB to discharge from ICU 6.33 ± 3.76 days versus 8.46 ± 5.99 (p = 0.047). The median total duration of ICU stay and clinical outcomes were significantly better in the nonintubated patients in whom BAL-directed antimicrobial modification was implemented. Distribution of microorganisms based on BAL reports was as follows: Acinetobacter baumanii 45 (30%), Klebsiella pneumoniae 37 (24.66%), Escherichia coli 9 (6%), and Pseudomonas aeruginosa 9 (6%). Conclusion. A change in antimicrobial therapy based on BAL data was associated with improved outcomes. The commonest bacterial isolate in the BAL fluid was Acinetobacter baumanii.
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Affiliation(s)
- Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Vrinda Mariya Elenjickal
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Dharma U. Shetty
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mahsheeba Asbin
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Magazine R, Chogtu B, Bhat A. Role of Angiotensin Converting Enzyme-2 and its modulation in disease: exploring new frontiers. Med Pharm Rep 2023; 96:146-153. [PMID: 37197279 PMCID: PMC10184530 DOI: 10.15386/mpr-2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/04/2022] [Accepted: 05/03/2022] [Indexed: 03/08/2023] Open
Abstract
Angiotensin Converting Enzyme-2 (ACE2), an important enzyme in the Renin Angiotensin Aldosterone System, degrades Angiotensin II (Ang II) into Angiotensin-(1-7) (Ang-(1-7)), whose actions are opposite to that of Ang II. Interestingly, SARS CoV-2 virus entry into human cells is mediated by ACE2. ACE2 receptors that are widely expressed in lungs and various other organs. Ang-(1-7) seems to have favorable effects on lungs, by preventing fibrosis in lung inflammation models, and exerts a similar action in cardiac and renal pathologies as well. Thus, modulation of Ang-(1-7) can be of potential benefit in chronic as well as acute inflammatory diseases affecting lungs and other organs. Upregulation of ACE2 by statins in different organs, and its consequent beneficial effects, have been demonstrated in many experimental studies, and also in a few clinical ones. This review aims at probing the role of ACE2 and its therapeutic modulation in pulmonary and extra pulmonary diseases, including COVID-19.
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Acharya P, Sharma D, Kamath S, Shenoy S, Magazine R. Microscopic polyangiitis with an atypical presentation. Indian J Rheumatol 2023. [DOI: 10.4103/injr.injr_169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Jalwa A, Singh R, Magazine R, Shetty S. A Study to Assess the Effect of Non-asthmatic Allergic Rhinitis on Pulmonary Functions-A Prospective Case-control Study. Indian J Otolaryngol Head Neck Surg 2022; 74:1627-1631. [PMID: 36452676 PMCID: PMC9702013 DOI: 10.1007/s12070-021-02785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022] Open
Abstract
Allergic rhinitis, beginning from childhood, is a global health problem. According to the literature, allergic rhinitis has been found association with asthma and other allergic manifestations. In this study we like to find out the significance and prognostic importance of spirometry in allergic rhinitis. The study was carried out over a period of 2 years, with 63 cases and controls each. Subjects in the age of 20-55 years with allergic rhinitis and SFAR score of > / = 7 were included as a case. Participants were interviewed and sent for spirometry. Controls were recruited from the retrospective data of healthy individuals with spirometry parameters done for health checkup. These controls had an SFAR score of < 7. All the data obtained were analyzed and compared between cases and controls. The mean age of the cases and controls were 33.17 ± 10.817 and 44.41 ± 7.4, respectively. Majority of cases and controls were males (60.3% and 57.1%). A statistically significant difference in FEF25-75% among cases and controls was noted (p = 0.00), thus proving probability of developing small airway obstruction in subjects with allergic rhinitis. Subjects with allergic rhinitis have a probability of developing small airway obstruction with subclinical changes, hence necessitating the need of regular follow-up.
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Affiliation(s)
- Ahmed Jalwa
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Rohit Singh
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Shama Shetty
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
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Weber SF, Ruby LC, Heller T, Hande M, Shastry BA, Acharya RV, Bhat R, Shankar S, Prabhu M, Mohapatra AK, Magazine R, Kadavigere R, Denkinger CM, Gehring S, Bélard S, Saravu K. TB disease patterns by HIV and diabetes status. Int J Tuberc Lung Dis 2022; 26:733-740. [PMID: 35898145 DOI: 10.5588/ijtld.21.0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB is commonly categorised as pulmonary (PTB) or extrapulmonary TB (EPTB). Knowledge of TB disease patterns (PTB and/or EPTB) and determining risk factors remains limited.METHODS: This was a prospective cohort study using point-of-care ultrasound (POCUS) in Indian patients with presumed TB. Clinical and imaging data were used to develop refined case definitions for PTB, concurrent PTB and EPTB (PTB + EPTB) and EPTB without PTB (EPTB). These groups were analysed by HIV (HIV+/-) and diabetes mellitus (DM+/-) status.RESULTS: Of 172 HIV-/DM- patients with TB, 48% had PTB, 23% PTB + EPTB and 29% had EPTB, totalling 52% with any EPTB (PTB + EPTB or EPTB). In HIV+/DM- patients with TB (n = 35), 6% had PTB, 40% had PTB + EPTB and 54% had EPTB, accounting for 94% with EPTB. In HIV-/DM+ patients with TB (n = 61), 61% had PTB, 28% had PTB + EPTB and 11% had EPTB, representing 39% with EPTB.CONCLUSION: Refined case definitions revealed high proportions of EPTB even without HIV or DM. HIV further altered the TB disease pattern towards EPTB and DM towards PTB. Therefore, the dichotomy between PTB or EPTB does not represent the actual spectrum of TB disease. EPTB should receive higher priority in research and clinical practice.
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Affiliation(s)
- S F Weber
- University Hospital Heidelberg, Division for Infectious Diseases and Tropical Medicine, Heidelberg, Germany
| | - L C Ruby
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T Heller
- Lighthouse Clinic Lilongwe, Kamuzu Central Hospital, Mzimba, Lilongwe, Malawi
| | - M Hande
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - B A Shastry
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R V Acharya
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R Bhat
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - S Shankar
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - M Prabhu
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - A K Mohapatra
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - C M Denkinger
- University Hospital Heidelberg, Division for Infectious Diseases and Tropical Medicine, Heidelberg, Germany, German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - S Gehring
- University Clinics Mainz, Department of Paediatrics, Mainz, Germany
| | - S Bélard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany, German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - K Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Datta D, Attur Prabhu R, Abdul Khader N, Prasad Nagaraju S, Ramachandra Rao I, Vinayak Shenoy S, Rangaswamy D, Bhojaraja MV, Thunga G, Magazine R, Shetty R. MO471: Adverse Drug Reactions and Drug–Drug Interaction in Chronic Kidney Disease With Tuberculosis. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The risk of developing tuberculosis (TB) is 10–25% in chronic kidney disease (CKD) patients. TB in CKD patients may have a mortality of 16–37%. Standard treatment with four drugs (Isoniazid, Rifampin, Pyrazinamide and Ethambutol) predisposes to side effects, drug interactions and incomplete adherence in this population. We studied adverse drug reactions and potential drug–drug interactions in CKD patients with TB.
METHOD
Consecutive patients with CKD and TB attending tertiary care hospitals in South India were included over a period of 12 months. CKD was diagnosed based on estimated GFR using CKD EPI and TB using standard methodology. Data on demographic details and adverse drug reactions were collected from case records. Potential drug–drug interactions were checked using Micromedex Drug-Reax® (Truven Health Analytics, Greenwood Village, Colorado, USA). Statistical analysis was done using SPSS version 20.
RESULTS
Of 1300 TB patients, 59 had CKD. The demographic details are as per Table 1.
CONCLUSION
In CKD with TB, adverse drug reactions were seen in 45.5% and potential drug–drug interactions were seen mostly with rifampin (28.81% in CKD).
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Affiliation(s)
- Divya Datta
- Nephrology, Kasturba Medical College, Manipal, India
| | | | | | | | | | | | | | | | - Girish Thunga
- Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, India
| | - Rahul Magazine
- Manipal, Respiratory Medicine, Kasturba Medical College, Manipal, India
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Magazine R, Sisupalan KN, Surendra VU, Chogtu B, Acharya PR, Guddattu V. Effect of Bronchoscopist-Directed Sedation and Other Factors on Patient Comfort during Diagnostic Flexible Bronchoscopy. Scientifica (Cairo) 2022; 2022:8643844. [PMID: 35096436 PMCID: PMC8799358 DOI: 10.1155/2022/8643844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The factors affecting patient comfort during flexible bronchoscopy are not sufficiently addressed in resource-limited countries, and a need to devise strategies to improve patient experience is felt. The present study was undertaken to assess the effect of sedation and other factors on patient comfort during flexible bronchoscopy. METHODS A total of 374 patients, aged ≥18 years undergoing flexible bronchoscopy, were enrolled in this prospective, single-center, cross-sectional study. The baseline clinical data of sedation and nonsedation groups were recorded. Anxiety level was assessed using Visual Analog Scale (VAS). Postprocedure VAS score (primary outcome measure) assessed the discomfort related to flexible bronchoscopy. Patient-reported willingness for a repeat procedure and occurrence of adverse events were used as secondary outcome measures. Based on the median of VAS score, the study population was divided into low discomfort and high discomfort groups, and the factors affecting comfort levels in these two groups were noted. RESULTS Postprocedural VAS score (median (Q1, Q3)) for sedation and nonsedation groups was 20 (15, 30) and 25 (20, 40), respectively (<0.001). Willingness for a repeat procedure was significantly more in the sedation group (p=0.002). In the low and high discomfort groups, the preprocedural anxiety level (median (Q1, Q3)) was 20 (10, 25) and 30 (20, 40), respectively (p < 0.001). CONCLUSION Bronchoscopist-directed sedation significantly reduces patient discomfort and increases their willingness for a repeat procedure. Midazolam-fentanyl combination and lower prebronchoscopy anxiety are associated with lower discomfort levels during flexible bronchoscopy. This study is registered with the Clinical Trial Registry of India (CTRI/2018/11/016328).
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Affiliation(s)
- Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Keerthi Nedumala Sisupalan
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Vyshak Uddur Surendra
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Preetam Rajgopal Acharya
- Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
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Magazine R, Antony T, Chogtu B, Prabhudev AM, Surendra VU, Guddattu V. Clinical usefulness of intermediate-dose dexmedetomidine (0.75 μg/kg) in flexible bronchoscopy - A prospective, randomized, double-blinded study. Indian J Pharmacol 2022; 53:440-447. [PMID: 34975131 PMCID: PMC8764980 DOI: 10.4103/ijp.ijp_446_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND: Dexmedetomidine, although an effective drug for conscious sedation during flexible bronchoscopy, has occasional side effects on the cardiovascular system which need to be addressed. MATERIALS AND METHODS: Patients between 18 and 65 years, requiring diagnostic flexible bronchoscopy, found eligible, after screening, were randomized to either receive 0.75 μg/kg intravenous dexmedetomidine over 10 min or intravenous midazolam 0.035 mg/kg over 1 min. Composite score was used as the primary outcome measure. Additional parameters recorded were: Hemodynamic variables, oxygen saturation, Ramsay sedation score, for pain intensity and distress Numerical Rating Scale, number of rescue medication doses, ease of doing bronchoscopy, Visual Analog Scale score for cough and response of the patient 24 h after bronchoscopy. RESULTS: In each group, 24 patients were enrolled. The composite score was in the ideal category in 24 patients in dexmedetomidine group and 21 in midazolam group, at nasopharynx (P = 0.234). The corresponding values at the level of trachea were 23 and 16 (P = 0.023). In dexmedetomidine group, patient response after 24 h of bronchoscopy showed quality of sedation to be excellent in 0 subjects, good in 13, fair in 9 and poor in 2 and discomfort to be nil in 7, mild 10, moderate in 7 and severe in 0. The corresponding values in midazolam group for quality of sedation were 0, 4, 14, 6, and for discomfort 0, 10, 14, 0. The Visual Analog Scale (VAS) for cough revealed a mean score of 0.800 and 1.812 (P = 0.011) during and 2.092 and 3.542 (P = 0.016) 24 h after bronchoscopy in the respective study groups. CONCLUSION: Low-dose dexmedetomidine (0.75 μg/kg single dose) appears to provide better patient comfort and equivalent safety profile when compared with midazolam.
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Affiliation(s)
- Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Thomas Antony
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Amithash Marulaiah Prabhudev
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vyshak Uddur Surendra
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Chogtu B, Priyadarshini P, Bhandary S, Kabirdev, Magazine R. Association of Use of Statins with Progression of Diabetic Retinopathy at a Tertiary Care Hospital in Southern India. J Curr Ophthalmol 2022; 34:234-240. [PMID: 36147261 PMCID: PMC9487012 DOI: 10.4103/joco.joco_70_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: To study the role of statin therapy on diabetic retinopathy (DR) progression. Methods: This retrospective study was carried out at a tertiary care hospital in southern India. Data were collected from the medical records of patients admitted from January 2013 to December 2018. Out of 1673 patients of DR enrolled in the study, 171 met the inclusion criteria. Patients' demographic data, drug history, clinical characteristics, and laboratory investigations were recorded as per the pro forma. The patients were divided into statin users and nonusers. The results were analyzed to compare the DR progression between the two groups. Results: DR progressed in 67% of nonstatin users and 37% of statin users (P < 0.001). The use of statins decreased the risk of DR progression (P < 0.001). Center-involving macular edema was seen in 8 of 79 statin users (10%) and 16 of 92 statin nonusers (16%) based on optical coherence tomography findings during the follow-up period (P = 0.17). Conclusion: In patients with type 2 diabetes, lipid-lowering therapy with statins has the potential to retard DR progression.
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Krishnan NV, Pujary K, Bhandarkar AM, Devadas U, Magazine R. Videostroboscopy and Voice Profile in Long-Term Combination Inhaler Users With Obstructive Lower Airway Disease. Otolaryngol Head Neck Surg 2021; 166:927-932. [PMID: 34311589 DOI: 10.1177/01945998211031449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Dysphonia is one of the most common side effects of long-term inhaler therapy containing corticosteroids in asthma or asthma-chronic obstructive pulmonary disease overlap (ACO) patients. This common, often reversible side effect is due to the structural changes in the vocal folds resulting from steroid deposition. This study determines the structural changes and voice profile of patients on long-term inhaler therapy by videostroboscopy and perceptual voice profile analysis. It also determines the duration, formulation, and drug delivery system producing the least side effects during therapy. STUDY DESIGN Prospective case-control study. SETTING Tertiary care hospital. METHODS In total, 196 patients diagnosed with moderate to severe asthma or ACO were divided into cases (patients on at least 6-month combination inhaler therapy) and controls (newly diagnosed patients not on inhaler therapy) and recruited in the study. They were assessed by videostroboscopy for structural changes and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and strain) perceptual scale for voice profile changes. RESULTS The prevalence of dysphonia was significantly higher in cases (62.2%) than controls (27.6%). Prevalence of laryngeal structural changes and voice profile changes were higher in cases. The prevalence of dysphonia and structural changes among cases was much lower when a spacer was used (P < .001). CONCLUSION This study adds evidence to the long-term side effects of combination inhaler therapy containing corticosteroids on the larynx as demonstrated by videostroboscopy and perceptual voice profile analysis. It also propagates the use of spacers in drug delivery to reduce the prevalence of side effects during long-term inhaler therapy.
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Affiliation(s)
- Neethu V Krishnan
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kailesh Pujary
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay M Bhandarkar
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Usha Devadas
- Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rahul Magazine
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Shetty PA, Magazine R, Chogtu B. Patient outlook on bedside teaching in a medical school. J Taibah Univ Med Sci 2021; 16:50-56. [PMID: 33603632 PMCID: PMC7858025 DOI: 10.1016/j.jtumed.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Bedside teaching is an important element of training undergraduate and postgraduate medical students to attain clinical skills. The perceptions of patients about bedside teaching vary significantly based on their understanding of the educational climate in hospitals. This study aimed to evaluate the views of diverse groups of patients on bedside teaching and the degree of involvement of medical students in their clinical decision-making processes. Methods This was a cross-sectional study conducted among patients admitted to various departments of a tertiary care hospital. A total of 200 patients were surveyed by students using a questionnaire, which covered their knowledge, views, and expectations with respect to medical students in hospital settings and bedside teaching. Results The majority (83.5%) of patients surveyed felt that the students made the hospital environment more comfortable and friendly. Male patients chose to permit students' involvement more than female patients. Among the female patients, teens, young adults, and unmarried women were more positive towards students' direct participation in their physical examinations. Health concerns and stress were issues for adults and older patients, whereas privacy and confidentiality concerned the younger age group. Patients admitted to the obstetrics and gynaecology wards were more likely to reject student involvement in hospital procedures than patients in other departments. Conclusion Most of the patients had a markedly positive attitude towards bedside teaching. Alternative methods of teaching can be implemented in situations where patients feel uncomfortable with students' involvement during their hospital stay.
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Affiliation(s)
- Pritam A Shetty
- Medical student, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sareen S, Pai S, Bhatia L, Kayarkatte M, Srinivas S, Pai K, Magazine R. A rare case of cutaneous tuberculosis with atypical disseminated tuberculids and scrotal ulcer in an immunocompetent patient. Dermatol Ther 2021; 34:e14838. [PMID: 33527583 DOI: 10.1111/dth.14838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/30/2020] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Suhani Sareen
- Department of Dermatology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Sathish Pai
- Department of Dermatology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Lavin Bhatia
- Department of Dermatology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Manasa Kayarkatte
- Department of Dermatology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Srilatha Srinivas
- Pathology and Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Kanthilatha Pai
- Pathology and Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Rahul Magazine
- Pulmonary Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
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Abstract
Pulmonary Rehabilitation (PR) is an essential and comprehensive intervention recommended in the management of people with chronic respiratory diseases (CRD). Scientific evidence suggests significant health benefits with respect to repeated hospital admissions, exercise tolerance and Health Related Quality of Life (HRQoL). However, the uptake and completion of PR programs are globally low. In order to understand the factors contributing to underutilization of PR, it is important to review and recognize the barriers to PR program. A literature search was conducted on Medline (PubMed) database. After reviewing the title and abstracts, full text articles were scrutinized for their relevance. Twenty-two studies involving factors affecting the uptake, participation and completion of PR program were included in this review. Reported barriers to PR were healthcare system, healthcare professional and patient related factors. Primary factors related to healthcare system and healthcare professionals were fewer PR centers, accessibility inconvenience, lack of awareness of PR program, low knowledge of referral process and lack of interdisciplinary teamwork. Difficulties faced by patients to take up and/or to complete PR programs were lack of transportation, co-morbidities, lack of perceived benefits, socio-economic status and lack of funding facilities. Identified and reported barriers resulted into discontinuity between knowledge of health benefits and utilization of PR service for patients with CRDs. Addressing the barriers would accelerate the healthcare professionals' referral and patients to avail the health benefits of rehabilitation service.
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Affiliation(s)
- Anulucia Augustine
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anup Bhat
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Garg R, Shaw T, Vandana KE, Magazine R, Mukhopadhyay C. Melioidosis In Suspected Recurrent Tuberculosis: A disease in disguise. J Infect Dev Ctries 2020; 14:312-316. [PMID: 32235093 DOI: 10.3855/jidc.12051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/06/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Melioidosis, caused by the soil saprophyte B. pseudomallei, is a 'neglected' infectious disease in many Asian countries. It remained undiagnosed or misdiagnosed in India for long due to a lack of awareness and facilities to diagnose the disease; however, it is slowly gaining the status of an emerging disease recently. The disease is well known as a great mimicker, as the presentations are very similar to many other tropical diseases, and more importantly, to tuberculosis . METHODOLOGY A prospective observational study was conducted from January 2016 - December 2018 to find the occurance of melioidosis in patients with 'recurrent' tuberculosis infection in a tertiary health care hospital from southern India. All suspected cases of recurrent tuberculosis were simultaneously tested for the presence of B. pseudomallei, and basic demographics and clinical details were documented. RESULT Among 11,138 patients admitted with suspected tuberculosis infection, 586 (5.2%) patients were confirmed. There was recurrent Mycobacterium tuberculosis infection in 11/586 (1.8%) cases, and 7/586 (1.2%) had growth of B. pseudomallei in culture. Patients with melioidosis had either pulmonary involvement, or bone and joint infections and deep abscesses. Uncontrolled diabetes mellitus was the major risk factor. CONCLUSION The study foreshadows the need for prompt and accurate microbiological diagnosis along with a high index of suspicion from the clinicians in countries which are endemic for both melioidosis and tuberculosis, thus ameliorating the irrational anti-tuberculosis treatment.
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Affiliation(s)
- Rahul Garg
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104.
| | - Tushar Shaw
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104.
| | - Kalwaje E Vandana
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104.
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104.
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104.
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Magazine R, Venkatachala SK, Goneppanavar U, Surendra VU, Guddattu V, Chogtu B. Comparison of midazolam and low-dose dexmedetomidine in flexible bronchoscopy: A prospective, randomized, double-blinded study. Indian J Pharmacol 2020; 52:23-30. [PMID: 32201443 PMCID: PMC7074428 DOI: 10.4103/ijp.ijp_287_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/17/2019] [Accepted: 01/30/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dexmedetomidine is a clinically useful drug for providing sedation, but concern regarding its cardiovascular side effect profile can limit its widespread use during routine diagnostic flexible bronchoscopy (FB). MATERIALS AND METHODS Patients between 18 and 65 years of age, who required diagnostic FB, were screened. Eligible patients were randomized to either receive 0.5 μg/kg intravenous dexmedetomidine over 10 min or intravenous midazolam 0.035 mg/kg over 1 min. If required, rescue medication (intravenous midazolam 0.5 mg bolus) was administered. The primary outcome measure was the composite score. Other parameters observed were numerical rating scale, hemodynamic variables, oxygen saturation, number of doses of rescue medication, visual analog scale score for cough, ease of bronchoscopy, Ramsay Sedation Score, and postprocedure patient response after 24 h of bronchoscopy. RESULTS A total of 54 patients were enrolled, 27 in each group. Total composite score (mean ± standard deviation) in dexmedetomidine and midazolam group at nasopharynx was 7.04 ± 2.19 and 6.59 ± 1.55 (P = 0.387), respectively. The corresponding values at the level of trachea were 9.22 ± 3.69 and 8.63 ± 2.13 (P = 0.475). In the dexmedetomidine group, patient response after 24 h of bronchoscopy showed the quality of sedation to be excellent in three patients, good in 10, fair in 11, and poor in 3 and discomfort to be nil in 14, mild 7, moderate in 3, and severe in 3. The corresponding values in the midazolam group for the quality of sedation were 0, 9, 18, 0 and for discomfort 10, 16, 1, 0. Other parameters did not reveal any statistically significant difference. CONCLUSION Dexmedetomidine at a dose of 0.5 μg/kg may provide clinically useful conscious sedation, comparable to midazolam.
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Affiliation(s)
- Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shivaraj Kumar Venkatachala
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Umesh Goneppanavar
- Department of Anaesthesia, Dharwad Institute of Mental Health and Neurosciences, Dharwad and Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Vyshak Uddur Surendra
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Prabhudev AM, Antony T, Surendra VU, Magazine R, Roy FA. A Rare Co-existence of Pulmonary Nocardiosis with E.coli Infection in Immunocompetent Host. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/43633.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Prabhudev AM, Chogtu B, Magazine R. Comparison of midazolam with fentanyl-midazolam combination during flexible bronchoscopy: A randomized, double-blind, placebo-controlled study. Indian J Pharmacol 2018; 49:304-311. [PMID: 29326491 PMCID: PMC5754938 DOI: 10.4103/ijp.ijp_683_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Sedation during flexible bronchoscopy is desirable, but the drugs and the dosage protocols that are used vary. OBJECTIVE: To study and compare the effects of midazolam with fentanyl-midazolam combination during flexible bronchoscopy. MATERIALS AND METHODS: The study was conducted on 144 patients, from October 2013 to July 2015. They answered Hospital Anxiety and Depression Scale-Anxiety subscale and a prebronchoscopy questionnaire to assess their expectation toward flexible bronchoscopy. The patients were randomized into three groups: placebo, midazolam, and fentanyl-midazolam. Vitals signs including heart rate, respiratory rate, blood pressure, and oxygen saturation (SpO2) were recorded. Furthermore, Ramsay Sedation Scale was assessed during the procedure. Primary outcome measure was the composite score of patient-reported tolerance and satisfaction (assessed after the procedure). Secondary outcome measures were composite score of physician-reported feasibility of the procedure, hemodynamic changes during bronchoscopy, and side effects. RESULTS: Patient-reported tolerance and satisfaction composite scores (median, interquartile range) for placebo, midazolam, and fentanyl-midazolam groups were 54 (52, 57), 59 (57, 61.5), 62 (58.5, 66), respectively; P < 0.001. Physician-reported feasibility composite scores (median, interquartile range) for the respective groups were 24.5 (20.5, 28), 25 (21, 27), 26 (25, 29); P = 0.004. There was no significant difference between the groups so far as mean heart rate (P = 0.305), mean systolic blood pressure (P = 0.532), mean diastolic blood pressure (P = 0.516), mean respiratory rate (P = 0.131), and mean SpO2 (P = 0.968) were concerned. CONCLUSION: Conscious sedation with fentanyl and midazolam combination can result in better patient and operator satisfaction when compared with midazolam alone.
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Affiliation(s)
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Magazine R, Surendra VU, Chogtu B. Comparison of oral montelukast with oral ozagrel in acute asthma: A randomized, double-blind, placebo-controlled study. Lung India 2018; 35:16-20. [PMID: 29319028 PMCID: PMC5760861 DOI: 10.4103/lungindia.lungindia_226_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The need for more effective management of acute asthma has led to research on drugs which are otherwise approved for use in chronic asthma. Objective: To study and compare the effects of oral montelukast with oral ozagrel in acute asthma. Materials and Methods: One hundred and twenty patients with acute asthma were recruited for the study. Out of 120 study patients, forty each were randomized into placebo, montelukast, and ozagrel groups. After the first dose of the drug or placebo was administered, peak expiratory flow rate (PEFR), number of rescue medications and also vital signs were noted at 6 h, 12 h, 24 h, 48 h, and at discharge. In addition, same recordings were done on the morning (8 a.m. – 10 a.m.) following admission. The difference in mean PEFR of each group at above-mentioned time points was the primary endpoint whereas need for rescue medications the secondary end-point. Results: The respective mean PEFR recordings of the placebo, montelukast, and ozagrel groups at various time points were as follows: at 6 h (235.19 ± 3.18, 242.86 ± 3.26, 228.18 ± 3.25); at 12 h (254.37 ± 5.23, 265.62 ± 5.38, 242.99 ± 5.36); at 24 h (267.46 ± 7.41, 291.39 ± 7.61, 268.14 ± 7.58); and at 48 h (277.99 ± 7.35, 303.22 ± 7.56, 285.27 ± 7.53); and discharge (301.94 ± 7.07, 317.32 ± 7.27, 298.99 ± 7.23). The mean PEFR between the treatment groups were not statistically significant (P = 0.102). The mean PEFR in the three groups at 8–10 a.m. following admission was 257.60 ± 5.52, 264.23 ± 5.98, and 249.94 ± 5.96; P = 0.266. Total number of rescue doses needed were 7, 4, and 13, respectively (P = 0.67). Conclusion: Montelukast or ozagrel when added to the standard treatment of acute asthma does not result in any additional benefit.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vyshak Uddur Surendra
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Magazine R. Head Rotation Manoeuvre during Flexible Bronchoscopy. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/35203.11733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chogtu B, Malik DV, Magazine R, Shenoy VP. Mycobacterium fortuitum Infection at Umbilical Hernioplasty Site. J Clin Diagn Res 2017; 11:OD01-OD02. [PMID: 29207758 DOI: 10.7860/jcdr/2017/26618.10531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Non Tuberculous Mycobacteria (NTM) are a group of rapidly growing mycobacteria and are generally considered to be of low virulence. Of late, there has been an increase in incidence of infections due to these organisms. Among them, Mycobacterium fortuitum, M. chelonae and M. abscessus are the common species which have been identified. Though they are occasionally implicated in pulmonary infections, NTM are very commonly associated with cutaneous infections, especially surgical site infections. Identification of NTM infection at such sites should be suspected when there is delayed healing of the wound. Histopathological Examination (HPE) of the wound site may reveal a classical picture of granulomas, epithelioid cells and giant cells which may lead to a suspicion of tuberculosis. It is important to perform mycobacterial culture and sensitivity testing of the wound tissue as this helps to differentiate tuberculous and non tuberculous infections. Here, we present a case of a patient who underwent mesh hernioplasty for umbilical hernia and was diagnosed with M. fortuitum infection at the site of umbilical hernioplasty.
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Affiliation(s)
- Bharti Chogtu
- Associate Professor, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Daliparty Vasudev Malik
- Junior Resident, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Rahul Magazine
- Professor, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vishnu Prasad Shenoy
- Associate Professor, Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Chogtu B, Magaji N, Magazine R, Acharya PR. Pattern of Allergen Sensitivity among Patients with Bronchial Asthma and/or Allergic Rhinosinusitis in a Tertiary Care Centre of Southern India. J Clin Diagn Res 2017; 11:OC01-OC04. [PMID: 28969175 DOI: 10.7860/jcdr/2017/26973.10328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The distribution of aeroallergens varies among various geographical areas of India and the knowledge of allergen sensitivity pattern in this part of Southern Indian (Karnataka) is limited. This data can provide clinically useful information and better understanding of common allergies prevalent in this area. AIM To study the pattern of allergen sensitivity among patients with bronchial asthma and/or allergic rhinosinusitis. MATERIALS AND METHODS In this retrospective study, patients diagnosed with bronchial asthma and/or allergic rhinitis who underwent skin prick testing, were included in the study. Patients who had taken drugs that could affect the test results, within one week prior to testing were excluded. Also, patients on long-acting oral antihistamines within four weeks of testing and pregnant women were excluded. A total of 64 antigens were used which included eight types of pollens, eight types of dusts, six types of fungi, eight types of insects, two types of danders, wool and 31 types of food items. Skin prick testing was done as per standard protocol. RESULTS Out of 2219 patients, 1193 (53.8%) were males and 1026 (46.2%) were females. The mean age of the subjects was 41.47 (±14) years. There were 740 (33.3%) patients diagnosed with bronchial asthma, 357 (16.1%) allergic rhinitis and 1122 (50.6%) had both bronchial asthma and allergic rhinitis. Overall the highest percentage of skin-prick test positivity was found among insect allergens (24.45%) followed by dust (24.21%), grass and tree pollen (20.57%), fungus (13.92%) and food allergens (9.28%), in that order. Among the individual allergens, the highest percentage of skin-prick test positivity was present in rice grain dust allergen (33.30%) and the least common was chicken allergen (4.40%). CONCLUSION Among the allergen groups, insects and dusts elicited the highest percentage of skin-prick test positive results. Whereas, among all the individual allergens rice grain dust elicited highest percentage of positives.
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Affiliation(s)
- Bharti Chogtu
- Associate Professor, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Neha Magaji
- Senior Resident, Department of Pulmonary Medicine, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Rahul Magazine
- Professor, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Preetam R Acharya
- Associate Professor, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Magazine BC, Bhattacharjee D, Magazine R. Efficacy of statins in obese asthmatics. Res Social Adm Pharm 2017. [DOI: 10.1016/j.sapharm.2017.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chogtu B, Kuriachan S, Magazine R, Shetty KR, Kamath A, George MM, Tripathy A, Kumar DM. A prospective, randomized study: Evaluation of the effect of rosuvastatin in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Indian J Pharmacol 2017; 48:503-508. [PMID: 27721534 PMCID: PMC5051242 DOI: 10.4103/0253-7613.190721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Statins by their anti-inflammatory and endothelial stabilizing effect can be beneficial in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). The present study was done to evaluate the effect of rosuvastatin on pulmonary functions and quality of life (QOL) in patients with concomitant COPD and PH. Materials and Methods: It was a prospective, randomized, double-blind, placebo-controlled, study conducted in patients with COPD and PH. A total of sixty patients were assigned to receive either rosuvastatin 10 mg or placebo once a day in addition to their conventional treatment for 12 weeks. Routine blood investigations, pulmonary functions, echocardiogram, exercise capacity, and QOL using a questionnaire were assessed at the baseline and after 12 weeks. Results: In patients of rosuvastatin group, there was a statistically significant increase in peak expiratory flow rate (PEFR) (P = 0.04) but no significant change in other pulmonary functions: Forced vital capacity (FVC), forced expiratory volume at 1 s (FVC, FEV1, FEV1/FVC), and echocardiogram parameters. There was a significant increase in 6-min walk test (6-min walk distance) (P = 0.03) at the end of 12 weeks. On comparing with placebo, rosuvastatin showed a significant reduction (P = 0.045) in COPD exacerbations while adverse effects did not differ. Conclusion: Statins have a favorable effect on patients with COPD and PH regarding the improvement in PEFR, COPD exacerbations, and exercise capacity. Such effects can be beneficial in these patients and more so in patients with concomitant coronary artery disease or hyperlipidemia where long-term benefits of statins have been established.
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Affiliation(s)
- Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sanitha Kuriachan
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - K Ranjan Shetty
- Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Manu Mathew George
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Amruta Tripathy
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - D Mahesh Kumar
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Magazine R, Rao S, Chogtu B, Venkateswaran R, Shahul HA, Goneppanavar U. Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience. Lung India 2017; 34:38-42. [PMID: 28144059 PMCID: PMC5234197 DOI: 10.4103/0970-2113.197097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. Aim: To study the epidemiological profile of ARDS patients. Setting: A tertiary care hospital in Karnataka, India. Materials and Methods: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010–2012. Data collected included the clinical features and severity scoring parameters. Results: The mean age of the study population was 42.92 ± 13.91 years. The causes of ARDS included pneumonia (n = 35, 23.3%), scrub typhus (n = 33, 22%), leptospirosis (n = 11, 7.3%), malaria (n = 6, 4%), influenza (H1N1) (n = 10, 6.7%), pulmonary tuberculosis (n = 2, 1.3%), dengue (n = 1, 0.7%), abdominal sepsis (n = 16, 10.7%), skin infection (n = 3, 2%), unknown cause of sepsis (n = 18, 12%), and nonseptic causes (n = 15, 10%). A total of 77 (51.3%) patients survived, 66 (44%) expired, and 7 (4.7%) were discharged against medical advice (AMA). Preexisting comorbidities (46) were present in 13 survivors, 19 nonsurvivors, and four discharged AMA. History of surgery prior to the onset of ARDS was present in one survivor, 13 nonsurvivors, and one discharge AMA. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, and Sequential Organ Failure Assessment scores in survivors were 9.06 ± 4.3, 49.22 ± 14, and 6.43 ± 2.5 and in nonsurvivors 21.11 ± 7, 86.45 ± 23.5, and 10.6 ± 10, respectively. Conclusion: The most common cause of ARDS in our study was pneumonia, but a large percentage of cases were due to the tropical infections. Preexisting comorbidity, surgery prior to the onset of ARDS, higher severity scores, and organ failure scores were more frequently observed among nonsurvivors than survivors.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Shobitha Rao
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ramkumar Venkateswaran
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Hameed Aboobackar Shahul
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Umesh Goneppanavar
- Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
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Chogtu B, Holla S, Magazine R, Kamath A. Evaluation of relationship of inhaler technique with asthma control and quality of life. Indian J Pharmacol 2017; 49:110-115. [PMID: 28458433 PMCID: PMC5351222 DOI: 10.4103/0253-7613.201012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 12/07/2016] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There is a need to assess erroneous steps in the use of inhaler devices in people who have asthma. The objectives of this study were to assess the inhaler technique in patients who have asthma, the factors affecting improper technique, and the association of inhaler use with asthma control, hospital visits, and quality of life (QOL) of patients who have asthma. METHODS It was an observational, prospective, cross-sectional study conducted on patients with bronchial asthma. Patients were enrolled in the study; their history was recorded and they were asked to use inhaler in the presence of an investigator and the technique was scored. Asthma control and QOL of patients were assessed using asthma control questionnaire and Mini Asthma QOL questionnaire. RESULTS A total of 330 patients completed the study. Nearly 36.6% of the patients performed the steps incorrectly. Breathing normally for 30-60 min postinhaler use was the most common step done incorrectly. Patients with poorly controlled asthma (P < 0.001) and those with predicted forced expiratory volume at 1 s <70% performed the steps erroneously (P < 0.001). CONCLUSION All patients, particularly those above 40 years, should be given proper instructions regarding inhaler use to obtain therapeutic advantage.
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Affiliation(s)
- Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sadhana Holla
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Chogtu B, Surendra VU, Magazine R, Acharya PR, Yerrapragada DB. Rifampicin-Induced Concomitant Renal Injury and Hepatitis. J Clin Diagn Res 2016; 10:OD18-OD19. [PMID: 27790502 DOI: 10.7860/jcdr/2016/21030.8578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
Adverse drug reactions are not unusual during Anti-Tubercular Therapy (ATT). One of the common complications of anti-tubercular treatment is drug induced hepatitis and renal insufficiency has also been reported. Renal failure and/or hepatitis encountered during treatment of tuberculosis can have varied aetiologies: drug induced, concomitant viral infection, pre-existing co-morbidities or a combination of these. Since, hepatitis and/or renal insufficiency can be life threatening a prompt diagnosis is warranted, where drugs should be kept as one of the important cause. Identifying the drug helps in treating hepatitis and/or renal insufficiency along with helping the physician to change the combination of ATT regimen. Rifampicin is one of the most important first line drugs in the treatment of tuberculosis. Hepatitis, epigastric distress, anaemia, thrombocytopenia, and interstitial nephritis are reported adverse drug reactions to rifampicin. As per literature rifampicin induced renal toxicity is usually seen on rifampicin re-exposure, or rifampicin administration on alternate days, both being present in this case. Here we are reporting a case of ATT induced renal failure with concomitant hepatitis where rifampicin was suspected to be the cause.
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Affiliation(s)
- Bharti Chogtu
- Associate Professor, Department of Pharmacology, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Vyshak Uddur Surendra
- Postgraduate Student, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Rahul Magazine
- Professor, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Preetam Rajgopal Acharya
- Associate Professor, Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal University , Karnataka, India
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Chogtu B, Magazine R, Bairy KL. Response to comment on: Statin use and risk of diabetes mellitus. World J Diabetes 2016; 7:481-482. [PMID: 27795822 PMCID: PMC5065668 DOI: 10.4239/wjd.v7.i18.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/15/2016] [Accepted: 08/18/2016] [Indexed: 02/05/2023] Open
Abstract
In letter to the editor “Comment on: Statin use and risk of diabetes mellitus” authors found the statement “pravastatin 40 mg/d reduced the risk of diabetes by 30% in West of Scotland Coronary Prevention study” erroneous. As per our opinion the statement is right but had been referenced incorrectly.
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Magazine R, Shahul HA, Chogtu B, Kamath A. Comparison of oral montelukast with oral zileuton in acute asthma: A randomized, double-blind, placebo-controlled study. Lung India 2016; 33:281-6. [PMID: 27185992 PMCID: PMC4857564 DOI: 10.4103/0970-2113.180805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Leukotriene modifiers have an established role in the management of chronic asthma but their role in acute asthma is still under evaluation. Objective: To study and compare the effects of oral montelukast with oral zileuton in acute asthma. Materials and Methods: This study included 120 asthmatics and was conducted from September 2012 to March 2014. Patients were randomized into three different groups to receive montelukast or zileuton or placebo in addition to standard treatment for asthma exacerbation. Peak expiratory flow rate (PEFR) values, details of rescue medication and vital signs were recorded at 6 h, 12 h, 24 h, and 48 h of drug or placebo administration and at discharge. Additional recording was done in the morning (8–10 am) following admission. The primary endpoint was the mean PEFR of each group at these time points; the secondary end point being the need for rescue medications. Results: The mean PEFR recordings of the three study groups – placebo, montelukast, and zileuton – respectively, at various time points were as follows: at 6 h (223.25 ± 90.40, 199.00 ± 82.52, 233.75 ± 84.05; P = 0.240); at 12 h (271.00 ± 109.38, 251.50 ± 101.44, 309.50 ± 129.63; P = 0.048); at 24 h (288.25 ± 114.26, 269.00 ± 107.51, 324.50 ± 127.88; P = 0.080); and at 48 h (295.00 ± 114.80, 293.50 ± 113.24, 344.75 ± 119.91; P = 0.015); discharge (305.00 ± 118.56, 305.25 ± 119.51, 361.25 ± 119.70; P = 0.010). The mean PEFR for the three study groups at 8–10 am on the morning following admission was 268.75 ± 111.43, 252.50 ± 99.99, 306.75 ± 114.44; P = 0.047. Total rescue doses needed were 10, 1, and 0, respectively (P = 0.049). Conclusion: Zileuton is better than montelukast as an additional drug in acute asthma and results in significant improvement in lung function, and reduction in the need for rescue medications.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Hameed Aboobackar Shahul
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Chogtu B, Bhattacharjee D, Magazine R. Epigenetics: The New Frontier in the Landscape of Asthma. Scientifica (Cairo) 2016; 2016:4638949. [PMID: 27293973 PMCID: PMC4879257 DOI: 10.1155/2016/4638949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/19/2016] [Indexed: 06/06/2023]
Abstract
Over the years, on a global scale, asthma has continued to remain one of the leading causes of morbidity, irrespective of age, sex, or social bearings. This is despite the prevalence of varied therapeutic options to counter the pathogenesis of asthma. Asthma, as a disease per se, is a very complex one. Scientists all over the world have been trying to obtain a lucid understanding of the machinations behind asthma. This has led to many theories and conjectures. However, none of the scientific disciplines have been able to provide the missing links in the chain of asthma pathogenesis. This was until epigenetics stepped into the picture. Though epigenetic research in asthma is in its nascent stages, it has led to very exciting results, especially with regard to explaining the massive influence of environment on development of asthma and its varied phenotypes. However, there remains a lot of work to be done, especially with regard to understanding how the interactions between immune system, epigenome, and environment lead to asthma. But introduction of epigenetics has infused a fresh lease of life in research into asthma and the mood among the scientific community is that of cautious optimism.
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Affiliation(s)
- Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Karnataka 576104, India
| | - Dipanjan Bhattacharjee
- Department of Pharmacology, Kasturba Medical College, Manipal University, Karnataka 576104, India
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Karnataka 576104, India
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Abstract
With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader's work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.
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Affiliation(s)
- Goneppanavar Umesh
- Department of Anaesthesia, Dharwad Institute of Mental Health and Neuro Sciences, Dharwad, Karnataka, India
| | | | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Abstract
The 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, statins, are widely used in the primary and secondary prevention of cardiovascular diseases to lower serum cholesterol levels. As type 2 diabetes mellitus is accompanied by dyslipidemia, statins have a major role in preventing the long term complications in diabetes and are recommended for diabetics with normal low density lipoprotein levels as well. In 2012, United States Food and Drug Administration released changes to statin safety label to include that statins have been found to increase glycosylated haemoglobin and fasting serum glucose levels. Many studies done on patients with cardiovascular risk factors have shown that statins have diabetogenic potential and the effect varies as per the dosage and type used. The various mechanisms for this effect have been proposed and one of them is downregulation of glucose transporters by the statins. The recommendations by the investigators are that though statins can have diabetogenic risk, they have more long term benefits which can outweigh the risk. In elderly patients and those with metabolic syndrome, as the risk of diabetes increase, the statins should be used cautiously. Other than a subset of population with risk for diabetes; statins still have long term survival benefits in most of the patients.
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Magazine R, Rao S, Chogtu B. Prescribing Patterns of Drugs in Acute Respiratory Distress Syndrome (ARDS): An Observational Study. J Clin Diagn Res 2015; 9:FC01-4. [PMID: 25859465 PMCID: PMC4378747 DOI: 10.7860/jcdr/2015/10411.5519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/11/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Acute respiratory distress syndrome (ARDS) is characterized by acute respiratory failure and is associated with wide range of clinical disorders. Controversy prevails over the pharmacological intervention in this disease. The aim of the study was to observe the prescribing pattern of drugs in patients with ARDS managed at a tertiary care hospital. MATERIALS AND METHODS This observational study was conducted at tertiary care hospital in India. Data of patients admitted from January 2010 to December 2012 was collected. Patients aged more than 18 years admitted in ICU, who were diagnosed to have ARDS during the study period, were included. A total of 150 patients of ARDS were selected. Data was collected as per the pre designed proforma and it included patients' age, gender, clinical disorders precipitating ARDS, prescribing pattern of drugs and outcome. The data of the subjects was collected till discharge from hospital or death. RESULTS Infection was the cause of ARDS in 81.3% (n=122) of subjects. Antibiotics were prescribed in all the subjects and beta-lactams were prescribed in 97.3% (n=146). 41.3% (n=62) were prescribed corticosteroids, 39.3% (n=59) diuretics and 89.3% (n=134) intravenous fluids. CONCLUSION The outcome of patients on different pharmacological treatment did not show any statistically significant difference.
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Affiliation(s)
- Rahul Magazine
- Associate Professor, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Shobitha Rao
- Student, Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Bharti Chogtu
- Associate Professor, Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Abstract
A 53-year-old man with a significant smoking history presented with chronic cough, exertional breathlessness, intermittent fever, weight loss and anorexia. A review of his past medical records revealed he was diagnosed to have sputum smear-positive pulmonary tuberculosis 5 years earlier, for which he had received multiple courses of incomplete antitubercular therapy. This time, though he was primarily suspected to have active pulmonary tuberculosis, lack of microbiological evidence and further investigations including histopathological evaluation of lung lesions confirmed a diagnosis of Marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALToma/BALToma). The patient was managed with radical radiation therapy to which he responded well.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | | | - Vidya Monappa
- Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
| | - Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal, Karnataka, India
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Magazine R, Chogtu B, Manu MK, Shahul HA. Tuberculous lymphadenitis and borderline leprosy in a patient with isolated unconjugated hyperbilirubinaemia. Case Reports 2014; 2014:bcr-2014-205311. [DOI: 10.1136/bcr-2014-205311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sharma A, Adiga S, Chogtu B, Mohapatra AK, Magazine R. Comparing the efficacy and influence on the quality of life of three classes of drugs used in bronchial asthma - a prospective study. J Clin Diagn Res 2014; 8:HC13-5. [PMID: 25386456 DOI: 10.7860/jcdr/2014/8999.4877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/11/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the efficacy of formoterol, montelukast and acebrophylline when used in combination with budesonide in patients with bronchial asthma and to determine their role in the improvement of the quality of life of patients. MATERIALS AND METHODS A total of 75 patients were divided into 3 groups based on treatment given - formoterol 6 mcg/puff + budesonide 100 mcg/puff combination inhaler, 2 puffs twice daily; oral montelukast 10 mg once daily + budesonide 100 mcg/puff, 2 puffs twice daily and oral acebrophylline 100 mg twice daily + budesonide 100 mcg/puff, 2 puffs twice daily. The patients were followed-up for 4 wk after initiating treatment. Spirometry values - forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR), before and after treatment were recorded. The quality of life was assessed before and after treatment using Asthma Quality of Life Questionnaire (AQLQ). Analysis was done using repeated measures ANOVA followed by Bonferroni's post-hoc test. RESULTS As compared to baseline values, FEV1, PEFR and Quality of Life showed significant improvement in all 3 groups after 4 wk of treatment (p-value < 0.01). Three patients in acebrophylline-treated group reported gastric irritation while no adverse effects were reported in the other groups. CONCLUSION Formoterol, montelukast or acebrophylline combined with inhaled corticosteroids have similar efficacy in the treatment of asthma.
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Affiliation(s)
- Ajitha Sharma
- Assistant Professor, Department of Pharmacology, Pondicherry Institute of Medical Sciences , Puducherry, India
| | - Shalini Adiga
- Professor, Department of Pharmacology, KMC , Manipal, Karnataka, India
| | - Bharti Chogtu
- Associate Professor, Department of Pharmacology, KMC , Manipal, Karnataka, India
| | | | - Rahul Magazine
- Professor, Department of Pulmonary Medicine, KMC , Manipal, Karnataka, India
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Parida A, Bairy KL, Chogtu B, Magazine R, Vidyasagar S. Comparison of Directly Observed Treatment Short Course (DOTS) with Self-Administered Therapy in Pulmonary Tuberculosis in Udupi District of Southern India. J Clin Diagn Res 2014; 8:HC29-31. [PMID: 25302217 DOI: 10.7860/jcdr/2014/8865.4721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/04/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Directly observed treatment short course (DOTS) and self-administered therapy (SAT) are the treatment options available for tuberculosis (TB). Studies conducted worldwide have shown difference in treatment outcome with these two treatment modalities. AIM The study was undertaken to compare treatment outcome of DOTS and SAT in patients of pulmonary TB taking SAT from a tertiary care hospital and DOTS from the DOTS centre of a government hospital. MATERIALS AND METHODS It was a retrospective comparative study. The case record files of patients with pulmonary TB diagnosed from March 2011 to February 2012 were analysed as per the proforma. The sample size of patients was 150 (75 each from DOTS and SAT). RESULTS The treatment outcome in DOTS group was cured 70.7%, treatment completed 1.3%, failure 5.3%, deaths 10.7%, defaulters 8% and transferred out 4% whereas in SAT group, cure was seen in 68% and 4% completed the treatment, 1.3% had treatment failure, and 26.7% were lost to follow up which included deaths, defaulters and those patients who switched over to other hospitals. The treatment success rate was similar (72%) in both groups. There was no statistically significant difference observed in the average weight gain at the end of treatment between the two groups. A total of 11 adverse drug reactions (4 DOTS, 7 SAT) were recorded in the study. CONCLUSION The study shows no statistically significant difference between success rate in patients taking DOTS and SAT.
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Affiliation(s)
- Amrita Parida
- Postgraduate, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - K L Bairy
- Professor and Head, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Bharti Chogtu
- Associate Professor, Department of Pharmacology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Rahul Magazine
- Additional Professor, Department of Pulmonary Medicine, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
| | - Sudha Vidyasagar
- Professor and Head, Department of Medicine, Kasturba Medical College , Manipal, Manipal University, Karnataka, India
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Abstract
A 42-year-old man with a significant smoking history presented with chronic expectorative cough and exertional shortness of breath with recent-onset hoarseness. Chest examination was essentially normal and cardiovascular examination was suggestive of aortic regurgitation. Ears, nose and throat evaluation showed left vocal cord palsy and CT scan revealed an aortic arch aneurysm. Ortner's syndrome refers to hoarseness due to recurrent laryngeal nerve palsy secondary to a cardiovascular abnormality. Aortic aneurysms usually present with chest pain, back pain or epigastric pain, depending on the site of the aneurysm. An aortic arch aneurysm presenting as hoarseness is extremely rare.
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Affiliation(s)
- Hameed Aboobackar Shahul
- Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal University, Manipal, Karnataka, India
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Umesh G, Magazine R. Agonal gasps of cardiac arrest victim can aid in confirming tracheal intubation using Umesh's intubation detector. Acta Anaesthesiol Taiwan 2013; 51:133-134. [PMID: 24148743 DOI: 10.1016/j.aat.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 03/14/2013] [Accepted: 03/19/2013] [Indexed: 06/02/2023]
Abstract
Several patients of cardiac arrest may be found in a state of agonal gasps that are of insufficient tidal volume and are not considered as a sign of life. However, this volume is sufficient enough to cause appreciable inflation and deflation of the reservoir bag of Umesh's intubation detector (UID) as evidenced in all 12 victims of cardiac arrest with gasping efforts in this study. Therefore, we conclude that the agonal gasps during cardiac arrest can reliably be used to confirm tracheal intubation using the UID device.
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Affiliation(s)
- Goneppanavar Umesh
- Department of Anaesthesiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal 576 104, Karnataka, India.
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Magazine R, Rao S. Utility of flexible fiber optic bronchoscopy: Experience from a tertiary care teaching hospital. J NTR Univ Health Sci 2013. [DOI: 10.4103/2277-8632.122159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Magazine R, Rao S, Chawla K, Chogtu B. Bacterial isolates from the bronchoalveolar lavage fluid of patients with pneumonia not responding to initial antimicrobial therapy. Sahel Med J 2013. [DOI: 10.4103/1118-8561.121914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Magazine R, Shetty R, Goneppanavar U, Mohapatra AK. Idiopathic clubbing confined to lower limb digits and idiopathic pulmonary fibrosis: an unusual association. Case Rep Pulmonol 2012; 2012:684285. [PMID: 23133780 PMCID: PMC3485489 DOI: 10.1155/2012/684285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/09/2012] [Indexed: 11/20/2022] Open
Abstract
A 62-year-old housewife presented to the chest outpatient department with a history of exertional breathlessness of four-month duration. On general physical examination, clubbing of toes was present with sparing of fingers. Chest examination revealed bilateral basal end inspiratory fine crepitations. A diagnosis of idiopathic pulmonary fibrosis was made on the basis of clinical, spirometric, and high-resolution computed tomography findings. Extensive evaluation could not reveal any cause for the differential clubbing. The unusual distribution of clubbing in a clinical condition, such as idiopathic pulmonary fibrosis, where generalized clubbing is expected can lead to a diagnostic confusion. This can lead to a further burden of investigations on the patient as clubbing being a significant finding cannot be ignored.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
| | - Ranjan Shetty
- Department of Cardiology, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
| | - Umesh Goneppanavar
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
| | - Aswini K. Mohapatra
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Karnataka, Manipal 576104, India
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Karnataka, India.
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Manu KM, Mohapatra AK, Magazine R. Right diaphragmatic hernia in an elderly man. Indian J Chest Dis Allied Sci 2012; 54:183-184. [PMID: 23008926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 71-year-old male presented with progressive exertional breathlessness and cough for the last four years. His breathlessness aggravated after a heavy meal and on lying down. He was a smoker, but had no co-morbidities. He did not remember any major trauma or surgery. Examination of the respiratory system revealed mediastinal shift to the left, diminished breath sounds over the whole of the right hemithorax and gurgling sounds all over, mainly the infrascapular area. Examination of other organ systems revealed no abnormality.
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Affiliation(s)
- K Mohan Manu
- Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India.
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Abstract
A 22-year-old unmarried man presented to the chest outpatient department with a history of productive cough of two-month duration. He also complained of pain and swelling on the anterior aspect of right side of chest of one-month duration. Imaging studies of the thorax, including chest roentgenography and computerized tomography, revealed an unruptured lung abscess which had herniated into the chest wall. Culture of pus aspirated from the chest wall swelling grew Mycobacterium tuberculosis. He was diagnosed to have a tuberculous lung abscess which had extended into the chest wall, without spillage into the pleural cavity or the bronchial tree. Antituberculosis drugs were prescribed, and he responded to the treatment with complete resolution of the lesion.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Magazine R, Pal M, Chogtu B, Nayak V. Capreomycin-induced optic neuritis in a case of multidrug resistant pulmonary tuberculosis. Indian J Pharmacol 2011; 42:247-8. [PMID: 20927254 PMCID: PMC2941619 DOI: 10.4103/0253-7613.68436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 06/15/2010] [Accepted: 06/24/2010] [Indexed: 11/27/2022] Open
Abstract
A patient of multidrug-resistant pulmonary tuberculosis was prescribed an anti-tubercular regimen containing capreomycin. Patient developed optic neuritis 3 months after starting treatment. Investigations did not reveal any specific cause for this ocular condition and on discontinuing capreomycin his vision recovered. We conclude that capreomycin is the cause of reversible optic neuritis in our case.
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Affiliation(s)
- Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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